Provider Demographics
NPI:1891096970
Name:THOMAS, TASHNA CLOVER (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TASHNA
Middle Name:CLOVER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 PARKSIDE PL
Mailing Address - Street 2:APT. 2H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4908
Mailing Address - Country:US
Mailing Address - Phone:347-275-5017
Mailing Address - Fax:
Practice Address - Street 1:3225 PARKSIDE PL
Practice Address - Street 2:APT. 2H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4908
Practice Address - Country:US
Practice Address - Phone:347-275-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302794-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse